On any given day, around 856 000 people are in prison in Europe. People in prison are substantially more likely to have used drugs, to use drugs regularly and to experience drug-related problems than their peers in the community. This is so, although there are significant differences between countries, and it is especially marked in the case of women. Yet, available data on the prevalence of drug use among people in prison, on people’s need for addiction care services, on the availability of such services in prison and on the drug supply to prisons remain scarce, and many challenges remain with regard to harmonisation and comparability between countries, despite some progress being made in recent years.

A better understanding of these issues is necessary to inform policy decisions, needs assessment, service planning and drug treatment organisation in prison.

This European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) Insights report provides a comprehensive overview of the current knowledge and latest developments
in the field of drug use and prison in the 30 countries reporting to the EMCDDA up to the end of 2020: the 27 EU Member States, Norway, Turkey and the United Kingdom. It also identifies important gaps in our knowledge, challenges for better provision of interventions and implications for policy and practice. The report provides an overview of the current situation in the field of drugs and prison in the following areas: drug use and drug-related problems among the prison population; the availability of drug-related services in prison; the evidence available for effective interventions in the prison setting; drug supply and supply reduction interventions; and future challenges relating to prison and drugs.

People in prison report high levels of lifetime prevalence of substance use before imprisonment and increased levels of consumption, especially of heroin, cocaine and amphetamines, compared with the general population. Although many people will stop injecting drugs when they enter prison, for those that continue, the use and reuse of contaminated equipment is not uncommon, contributing to an increased risk of transmission of infectious diseases in these settings.

Prison and drugs in Europe: current and future challenges

Between 2006 and 2019, Bolivia emerged as a world leader in formulating a participatory, non-violent model to gradually limit coca production in a safe and sustainable manner while simultaneously offering farmers realistic economic alternatives to coca. Our study finds that not only has this model reduced violence, but it has effectively expanded social and civil rights in hitherto marginal regions. In contrast, Peru has continued to conceptualize ‘drugs’ as a crime and security issue. This has led to U.S.-financed forced crop eradication, putting the burden onto impoverished farmers, generating violence and instability. At the request of farmers, the Peruvian government has made a tentative move towards implementing one aspect of Bolivia’s community control in Peru. Could it work? We address this question by focusing on participatory development with a special emphasis on the role of local organizations and the relationship between growers and the state.

Drawing on long-term ethnographic fieldwork, interviews, focus group discussions and secondary research, we find that for community control to have any chance of success in Peru, grassroots organizations must be strengthened and grower trust in the state created. The study also demonstrates that successful participatory development in drug crop regions is contingent on land titling and robust state investment, which strengthens farmer resolve to participate so as to avoid a return to the repression of the past.

Click here to read the full article (restricted access).

From criminals to citizens: The applicability of Bolivia’s community-based coca control policy to Peru

The criminalisation of drug use is prevalent globally, and the availability of harm reduction services is inadequate. However, harm reduction responses for sexualised drug use are even more inadequate, particularly compounded by criminalisation of sex between men. Gay men and other men who have sex with men and people who use stimulants are among the communities insufficiently served by existing or traditional harm reduction services. Furthermore, people engaging in chemsex have multiple vulnerabilities, leading to increased public health risks. For example, the risk of acquiring HIV is 26 times higher among gay men and other men who have sex with men, 29 times higher among people who inject drugs, and 13 times higher for transgender people, while the same groups also have elevated risks of acquiring hepatitis C infection. Widely supported by evidence, it is critical to provide support and access to public health services tailored to the needs of this population.

When talking about chemsex it is important to take into account the social determinants of health, social inequalities, criminalisation, stigma and discrimination faced by people engaging in chemsex - all of which affect health outcomes. These structural barriers continue to hinder access to health services both for men who have sex with men and people who use or inject drugs. It is well established that gay men and other men who have sex with men experience disproportionate levels of ill-health compared to the general population, and frequently face stigma, discrimination and criminalisation, which can lead to significant barriers in accessing appropriate health services. As people who engage in chemsex are at the intersection of two stigmatised communities (people who use drugs, and gay men and other men who have sex with men), they have an increased likelihood of facing discrimination or ill-treatment, which can lead to people disengaging or actively avoiding public health services. It is thus critical to provide harm reduction services to people involved in chemsex, in order to ensure they have access to the information and the equipment necessary to lower their health risks in a non-judgmental environment, without fear of discrimination.

The chemsex phenomenon has multiple characteristics that can increase the health and mental health risks of people involved. While precise descriptions of chemsex vary in international literature, definitions generally refer to chemsex as sexualised drug use among gay men and other men who have sex with men using multiple substances, where sexualised drug use refers to intentional and simultaneous use of drugs to facilitate, enhance, and/or prolong sex. Sometimes a specific set of substances is also included in the definition, though there are arguments that a broader definition would capture greater diversity and contingency of practices, and would thus contribute to an effective public health response. In addition, it has to be noted that groups other than gay men might be participating in chemsex, for example, in Portugal, transgender and non-binary people are also part of the chemsex scene.

Chemsex and harm reduction for gay men and other men who have sex with men

Consisting of five separate booklets, the 

 provides an in-depth analysis of the global drug markets and paints a comprehensive picture of the measurable effects and potential impact of the COVID-19 crisis on the world drug problem.

 is aimed not only at fostering greater international cooperation to counter the impact of the world drug problem on health, governance and security, but also, with its special focus on the impact of the COVID-19 pandemic, at assisting Member States in anticipating and addressing challenges that may arise in the near future.

World Drug Report 2021

The 64th session of the Commission on Narcotic Drugs (CND or Commission) took place between 12 and 19 April 2021. The session was conducted as a hybrid meeting in response to COVID-19. Despite this format, many familiar issues and themes remained visible. With much pre-CND attention focusing on the practicalities of the hybrid meeting, expectations were not especially high. The tabling of only five resolutions, none of them seemingly contentious, suggested another quiet year. Commemoration of the 60th and 50th anniversaries of the Single Convention on Narcotic Drugs and the Convention on Psychotropic Substances respectively certainly generated more than the usual levels of support for the UN drug control treaties in general. Yet, while agreement on some specific issues could be seen – notably around access to controlled substances for medical purposes – increasingly diverging views were also on view.

As has been the case in recent years, health and human rights were prominent features of statements and discussions within both the Plenary and the Committee of the Whole (CoW). In both settings, member states’ public rhetoric reflected vastly differing perspectives and domestic realities, including on occasion in relation to the use of the death penalty for drug-related offences. The disconnect between human rights and UN drug policy debates could also be seen in the CND’s Statement – technically a resolution – on the ongoing global health emergency and its impact on the implementation of member states’ joint commitments to address and counter all aspects of the ‘world drug problem’

In this case, while due to both the pandemic and the increasing use of ‘informals’ the dynamics of the negotiations remain unclear, the consensus document missed the opportunity to acknowledge drug law enforcement as one of the key drivers for mass incarceration, arbitrary detention, and human rights violations. Elsewhere in the CoW, debate around the equally fundamental concept of ‘social marginalisation’ resulted in unforeseen, protracted, and at times heated dispute.

It was in this context, however, that the US delegation demonstrated a significant shift in stance. Indeed, with the Biden-Harris administration having already announced in early April a more health-oriented approach to drug use within the USA, including ‘Enhancing evidence-based harm reduction efforts’, it was fascinating to see how this translated to the international stage. The US commitment to such a recalibrated outlook could certainly also be seen in its historic and explicit backing of harm reduction at the forum. Nonetheless, it remains unclear how the Biden administration’s ‘reformist drug strategy’ will play out in the CND and elsewhere, including within the UN system. As with most aspects of US foreign policy, complexity is rife. And nowhere was this more obvious than in relation to the Task Team in charge of the implementation of the UN System Common Position on drug-related matters. As was the case at the 2020 session, along with the Common Position, the Team emerged as an important, perhaps deepening, point of contention. Though not generating an enormous amount of debate, those statements that did comment on the work of the Task Team revealed not only ongoing divisions within the Commission, but also curious alignments. On this issue, the Russian and US delegations found themselves on the same side in opposing the Team and seeing it as a threat to the Vienna-based agencies.

Once again Russia was also particularly vocal in its hostility towards any perceived undermining and relaxation of the international drug control system, especially in relation to policy positions on cannabis. The Russian statement in the General Debate raised its own national drug control strategy’s identification of drugs as a national security priority and highlighted that one of its main aims ‘is to prevent any weakening or review of the global drug control regime, including via legalization of drugs’. Several other states also explicitly noted their concern over the legalisation of cannabis. Conversely, while Mexico referred to democratic efforts within the country leading to ‘responsible regulation’, it was only the Jamaican statement that could be seen as a challenge to the existing control framework. These reformist-oriented comments were very much in line with the delegation’s position on medical cannabis and its enthusiasm for the Commission’s rescheduling decision in late 2020. And on this issue, division was also apparent. With support coming from an eclectic mix of states, it was predominantly – though not exclusively – African nations, including perhaps misleadingly the Group of African States, that remained uncomfortable with the decisions; one that passed with the narrowest of margins In December.

Despite some anxiety among civil society in the lead up to the session, the hybrid format did little to impact engagement. In fact, in many ways, use of the UN’s ‘Interprefy’ web-based platform facilitated greater involvement, raising questions concerning the extent to which some hybrid practices should be continued in future Commission meetings. As such, while virtual, civil society presence remained strong across the week. This was the case in not only the now normalised ‘informal dialogues’ with UN bodies and side events, but also statements within the Plenary.

The 2020 Commission on Narcotic Drugs - Report of Proceedings

The 2019 Commission on Narcotic Drugs and its Ministerial Segment: Report of Proceedings

IDPC report of proceedings: The 2018 Commission on Narcotic Drugs

IDPC report of proceedings: The 2017 Commission on Narcotic Drugs

IDPC report of proceedings: The 2016 Commission on Narcotic Drugs and its special segment on preparations for the UNGASS on the world drug problem

IDPC report of proceedings: The 2015 Commission on Narcotic Drugs and its special segment on preparations for the UNGASS on the world drug problem

IDPC report of proceedings: The 2014 Commission on Narcotic Drugs and its High Level Segment

IDPC report of proceedings: The 2013 Commission on Narcotic Drugs

IDPC report of proceedings: The 2012 Commission on Narcotic Drugs

IDPC report of proceedings: The 2011 Commission on Narcotic Drugs

IDPC report of proceedings: The 2010 Commission on Narcotic Drugs

IDPC report of proceedings: The 2009 Commission on Narcotic Drugs

IDPC report of proceedings: The 2008 Commission on Narcotic Drugs

IDPC report of proceedings: The 2007 Commission on Narcotic Drugs

The 2021 Commission on Narcotic Drugs - Report of Proceedings

Since early 2020, countries have experienced an exponential rise in COVID-19 related infections and deaths. In an attempt to respond to this unprecedented spread of a deadly disease, governments around the world have invoked emergency executive powers, and/or adopted exceptional measures. In many cases, these have resulted in an expansion of law enforcement powers, in some cases in parallel with the side-lining of public health authorities. The necessity and effectiveness of such strategies have been heavily criticised, particularly in light of reports of abuse of force, arbitrary arrests and detention, and targeting of already marginalised, vulnerable, or over- policed communities (including ethnic minorities and migrant workers).

In Indonesia, Philippines, and Sri Lanka, national task forces are dominated by military or former military personnel with limited (if any) public health expertise.7 In Indonesia, it is estimated that there were at least 21 retired and active duty military officers directly involved in the decision-making process to control the pandemic.8 In the Philippines, discounting the active officers, President Rodrigo Duterte called in four retired generals to serve in leadership positions in efforts to mitigate COVID-19.9 In Sri Lanka, the Commander of the Army who leads NOCPCO – General Shavendra Silva – has faced accusations of war crimes.10

In these five countries, a mixture of police, military and enforcement personnel plays a prominent role in implementing COVID-19 control measures, including enforcing movement restrictions, social distancing, and mask wearing, checking temperatures, and managing quarantine facilities.

This securitisation of health protocols (as the enforcement of COVID-19 health protocols by police, military and other empowered officials) effectively turned a global public health crisis into a national security issue, with the virus identified as an enemy to be defeated, and the response framed as a war to be won. To ensure enforcement of COVID-19 protocols, new punishments for ‘violators” were introduced while fundamental rights were restricted; raising concerns about the legality, necessity, proportionality, and effectiveness of such measures.

The degree to which police and armed forces became involved in the design and implementation of COVID-19 travel and health protocols differ across the five countries, with three approaches identified: Blended civil response, securitised response, and militarised response.

Waging war against COVID-19: The securitisation of health responses in five Asian countries

In February 2019, the Home Secretary appointed Professor Dame Carol Black to undertake an independent review of drugs. This was to inform the government’s thinking on what more can be done to tackle the harm that drugs cause.

Dame Carol’s response to phase one of the commission provides a detailed analysis of the challenges posed by drug supply and demand, including the ways in which drugs fuel serious violence.

The second part of the review focuses on treatment, recovery and prevention giving consideration to adults and young people. The report’s aim is to make sure that vulnerable people with substance misuse problems get the support they need to recover and turn their lives around, in the community and in prison.

Dame Carol Black's independent review of drugs

By Dania Putri, Sam Shirley-Beavan, and Jamie Bridge

The COVID-19 pandemic and its related restrictions have brought many changes to the lives of people around the globe. It has also magnified existing inequalities, stigma and repression faced by certain marginalised communities such as people who use drugs.

However, the response to COVID-19 has also catalysed – and accelerated – some positive developments which are central to the wellbeing of people who use drugs, particularly in the field of harm reduction.

This report aims to provide a non-comprehensive review of some of the challenges, and the responses that have been applied to best protect the health and rights of people who use drugs. It has been written by Dania Putri (consultant), Sam Shirley-Beavan (Harm Reduction International), and Jamie Bridge (IDPC), to sit alongside a sister report focused on civil society advocacy during the pandemic: 

Innovation and Resilience in Times of Crisis: Civil society advocacy for drug policy reform under the COVID-19 pandemic

Dania Putri (Persepsi) is a consultant specialised in drug policy and social justice - this piece was commissioned by the International Drug Policy Consortium (IDPC); Sam Shirley-Beavan is a Research Analyst at Harm Reduction International; Jamie Bridge is the Chief Operations Officer at IDPC.

Innovation and resilience in times of crisis (Part 2): The response to COVID-19 from harm reduction services

Achieving the global target to eliminate HIV transmission among men who have sex with men (MSM) faces additional challenges from the lack of effective and scaled intervention to address a part of the population who use drugs in sexual settings (colloquially known as chemsex). In this report, we intend to deliver a practical toolkit for community-based organisations (CBOs) who work to improve health outcomes for MSM, particularly in Asian countries. This manual provides the contextual information on chemsex practices among MSM in Asia and offers information and interventions to respond to the situation appropriately.

Chemsex is a term generally used to describe the psychoactive substance use by MSM at the sex event-level, which typically includes mephedrone, GHB/GBL, or crystal methamphetamine. In Asia, the definition of chemsex (local terms: high fun, chemfun) seems to be adjusted to reflect the local pattern that may involve different drugs such as poppers, ecstasy, 5-metoxy-n or foxy, cocaine, ketamine, cannabis, or non-prescription drugs. Overall, the prevalence of this practices among MSM in Asia ranges from 3.1% to 30.8%. Several reasons influencing the decision of MSM in Asia to practice chemsex include the direct benefit of using the drug, persuasion from peer network, and external prejudice directed towards MSM existence. For now, the practice is more likely to be done by MSM who live in urban areas, have higher educational degree and income, and engage in habitual online behaviours, can be categorized as money boy, and have been identified as HIV+.

The use of drugs in sexual context has a strong relation with sexual risk behaviours that contributes to the increased risk of HIV transmission among MSM. The risk behaviours include higher sex frequency, unprotected sex with multiple partners, group sex, inconsistent condom use, internal ejaculation, lower expectation of sex partners to use condom, less concern on sex partners HIV and Sexual transmitted infection (STI) status, and imbalanced power relations. Consequently, the chemsex practice increases the odds of contracting HIV and other sexually acquired infections. In addition, some evidence indicates that chemsex practice is associated with mental health issue, such as suicidal risk, depression, and anxiety. The interplay between social inequities, substance use, and other health conditions can mutually reinforce health disparities such as HIV.

Chemsex in Asia - A community manual on sexualised substance use among men who have sex with men

By the United Nations High Commissioner for Human Rights

The murder of George Floyd on 25 May 2020 in Minnesota, United States of America, the mass protests that ensued in many countries and the momentous verdict against one responsible law enforcement official1 represent a seminal point in the fight against racism.

The worldwide mobilization of people calling for racial justice has forced a long- delayed reckoning with racism and shifted debates towards a focus on the systemic nature of racism and the institutions that perpetrate it. Prompted by this groundswell, on 17 June 2020 the Human Rights Council held an urgent debate on current racially inspired human rights violations, systemic racism, police brutality and violence against peaceful protests. On 19 June 2020, the Council adopted resolution 43/1 by consensus, in which it requested the United Nations High Commissioner for Human Rights to prepare a report on systemic racism, violations of international human rights law against Africans and people of African descent by law enforcement agencies, especially those incidents that resulted in the death of George Floyd and other Africans and people of African descent, to contribute to accountability and redress for victims; to examine government responses to anti-racism peaceful protests, including the alleged use of excessive force against protesters, bystanders and journalists; and to present a comprehensive report to the Council at its forty-seventh session.

In the present report – to be read in conjunction with an accompanying conference room paper – the High Commissioner examines the compounding inequalities that Africans and people of African descent face in all areas of life as a result of their marginalization and the lack of equal access to opportunities, resources and power. She highlights how systemic racism manifests itself in the area of law enforcement, focusing on incidents that result in death as its most visible and irreversible outcome, and on the consistent lack of accountability and redress for victims. The High Commissioner emphasizes the importance of ensuring that the voices of people of African descent and all those standing up against racism are heard. She considers the long-overdue need to confront the legacies of enslavement, the transatlantic trade in enslaved Africans and colonialism and to seek reparatory justice. Recognizing the imperative for action, in the present report she presents an agenda towards transformative change for racial justice and equality for Africans and people of African descent globally (see annex).

Promotion and protection of the human rights and fundamental freedoms of Africans and of people of African descent against excessive use of force and other human rights violations by law enforcement officers

In last year’s letter, we touched on the COVID-19 pandemic, then just bursting into our collective consciousness. A year later, much of the world is deep in another brutal wave, an outcome predicted by public health experts, and one that could and should have been prevented had political decision-makers been willing to act sooner and take human rights seriously.

This only underscores the lessons to be learned, many of them first imparted by the HIV pandemic, but too often ignored. COVID has demonstrated yet again that public health is fundamentally connected to human rights and that failing to respect and protect rights — and, especially, to take positive measures to fulfill rights — leads to more infection, illness, and death. Although COVID differs from HIV in important ways, they both travel along the fault lines of social inequities. The only way we will overcome both pandemics is if we act to respect, protect, and fulfill human rights.

This means ensuring freedom of expression: the silencing of health advocates leads to crucial delays in the response. It means realizing the right to health through equitable access to prevention tools including vaccines, to testing, and to treatment. It means ensuring workers’ rights to a safe workplace and to just working conditions, including paid sick leave. It means ending poverty, which leaves people with fewer options to protect their health. It means addressing the systemic racism that impedes access to care and treatment. It means accountability for the ageism and ableism that left care homes chronically underfunded and understaffed, and left some of those most vulnerable to get sick and die of COVID.

The importance of human rights in an effective response to a public health crisis was seen at the beginning of the HIV pandemic in the early 1980s; what was true then is still the case today with COVID, 40 years later.

A moment of breakthrough: Annual report 2020-2021

As a low-income West African country, Sierra Leone like other countries in West Africa have real “problematic” policies (drug laws) around drug use and people who use drugs (PWUD). This mission provided a better understanding of the context of drug use and drug policies or laws in Sierra Leone. The methodology included a bibliographic research, interviews (semi-structured, individuals and collectives) with many actors and different profiles, participant’s observations and focus groups (FGs), facilitated the collection of data that was used for analysis and recommendations. Out of an estimated number of 5000 ‘problematic/precarious’ PWUD in Freetown. They frequent at least a 100 open consumption scenes. It seems difficult to directly consume the drugs (Heroine and crack) on the spot. The main illegal drug consumed remain to be cannabis.

Particular to Sierra Leone, the consumption of synthetic cannabinoid is becoming more popular. However, we were able to observe and confirm a significant consumption of cocaine in the form of crack, and non- prescription drugs (tramadol, valium, diazepam, etc.). The participative observations are not able to directly confirm the presence of Heroine and injecting drug's users. NGOs and Drug Users confirmed their presence. “But they are few, and less numerous compared to Libéria”. At first, it was easy to observe, that interventions related to the use and abuse of drugs (from a global health point of view), will require a multisectorial and holistic approach. The analysis of the data collected revealed a strong will on the part of all stakeholders to reform the current laws or policies and strong expectations and needs on the part of the PWUD.

Sierra Leona have the first official Needles and Syringes exchange Program (NSP) in West Africa (WA). Funded by Global Fund (GF), this program was visited during the mission. Some known actors, are already investing in Harm Reduction (HR) Programs and on drugs policy. HR is included in the national plan and on the NFM3 of the GF. Globally, PWUD have declared their simple needs and Primary care: "for housing, food, access to healthcare and social integration", and “to put the drugs at distance”.

Publications